U.S. residents are less healthy,
less able to access health care than Canadians
Universal coverage appears to
reduce healthcare inequalities
Physicians for a National Health
ZNet, July 3, 2006, www.zmag.org/
A study by Harvard Medical School researchers
in the July, 2006 issue of the American Journal of Public Health
finds that U.S. residents are less healthy than Canadians. Moreover,
despite spending nearly twice as much per capita for health care,
U.S. residents experience more problems getting care and more
unmet health needs.
The study analyzes the Joint Canada-U.S.
Survey of Health, the first-ever cross national health survey
carried out by the two nations' official statistics agencies.
The authors found that U.S. residents were less healthy than Canadians,
with higher rates of nearly every serious chronic disease examined
in the survey, including diabetes, arthritis, and chronic lung
disease. U.S. residents also had more high blood pressure (18%
of U.S. residents versus only 14% for Canadians). U.S. rates of
obesity and sedentary lifestyle were higher; with 21% of U.S.
respondents reporting obesity versus 15% of Canadians. However,
U.S. residents were slightly less likely to smoke.
Canadians had better access to most types
of medical care (with the single exception of pap smears). Canadians
were 7% more likely to have a regular doctor and 19% less likely
to have an unmet health need. U.S. respondents were almost twice
as likely to go without a needed medicine due to cost (9.9% of
U.S. respondents couldn't afford medicine vs. 5.1% in Canada).
After taking into account income, age, sex, race and immigrant
status, Canadians were 33% more likely to have a regular doctor
and 27% less likely to have an unmet health need. For each of
these measures, the average Canadian did about as well as insured
Race and income disparities, although
present in both countries, were larger in the U.S. Nonwhites were
more likely than whites to have an unmet health need in the U.S.
(18.6% vs. 11.1%); while in Canada they were not (10.8% vs. 10.2%).
Notably, both white and non-white Canadians had fewer unmet health
needs than white U.S. residents. After taking into account income,
age, sex, race and immigrant status, poor U.S. residents (making
less than $20,000 per year) were 2.6 times less likely to have
a regular doctor than the affluent ( those making $70,000 or more).
In Canada, the poor were only 1.7 times less likely.
In the U.S., cost was the largest barrier
to care. More than seven times as many U.S. residents reported
going without needed care due to cost as Canadians (7.0% of U.S.
respondents vs. 0.8% of Canadians). Uninsured U.S. residents were
particularly vulnerable; 30.4% reported having an unmet health
need due to cost.
Lead author Dr. Karen Lasser, primary
care doctor at Cambridge Health Alliance and Instructor of Medicine
at Harvard commented, "Most of what we hear about the Canadian
health care system is negative; in particular, the long waiting
times for medical procedures. But we found that waiting times
affect few patients, only 3.5% of Canadians vs. 0.7% of people
in the U.S. No one ever talks about the fact that low-income and
minority patients fare better in Canada. Based on our findings,
if I had to choose between the two systems for my patients, I
would choose the Canadian system hands down."
"These findings raise serious questions
about what we're getting for the $2.1 trillion we're spending
on health care this year," said Dr. David Himmelstein, Associate
Professor of Medicine at Harvard and study co-author. "We
pay almost twice what Canada does for care, more than $6,000 for
every American, yet Canadians are healthier, and live 2 to 3 years
Dr. Steffie Woolhandler, also an Associate
Professor of Medicine at Harvard and study coauthor, commented:
"Our study, together with a recent study showing that people
in England are far healthier than Americans, is a terrible indictment
of the U.S. healthcare system. Universal coverage under a national
health insurance system is key to improving health. It's striking
that both whites and non-whites do better in Canada. A single-payer
national health insurance system would avoid thousands of needless
deaths and hundreds of thousands of medical bankruptcies each
year. In 1971, Congress almost passed national health insurance.
Since then, at least 630,000 Americans have died because they
failed to act. How much longer must we wait?"
The study used data from the Joint Canada/U.S.
survey of Health (JCUSH), conducted jointly by Statistics Canada
(the Canadian counterpart to the U.S. Census Bureau) and the U.S.
National Center for Health Statistics. The JCUSH surveyed 3,505
Canadians and 5,183 U.S. residents between November 2002 and March
2003 in order to gauge health status, rates of illness, behavioral
risk factors, use of health care, and access to health care services
in the two countries.
Physicians for a National Health Program
is an organization of 14,000 physicians that support single-payer
national health insurance. PNHP is headquartered in Chicago and
has chapters and spokespeople across the U.S. To contact a physician-spokesperson
in your area, contact email@example.com or call 312-782-6006. www.pnhp.org.